Few codes impacting eye-care practices among this year’s changes.

It’s that time of year again. On Oct. 1, the new ICD-10-CM codes for the following year go live for use. Thankfully, not many new codes or changes for 2022 affect eye care. Don’t forget that you must use these new codes right away and not delay until January 2022.

To see these code changes, Medicare has a specific file for download known as the Tabular Addenda (tinyurl.com/OPICD2022 ). There is also a file showing changes to the Official Guidelines; we’ll cover that as well.

Changes by chapter

Let’s go through the actual code changes in order by ICD-10 chapter and deal with the chapters for which we aren’t likely to be affected.

Chapters 1 through 6 each have only minor changes that won’t be common in eye care. There were no changes to Chapter 8 (ear and mastoid) at all from 2021. Chapter 9 through 17 all have non-eye related changes.

Our chapter 7 (eye and adnexa) has only one change, and it’s more an error correction than a true change to eliminate a “dash”; nothing else in our chapter changes at all! That change is:

• No Change - H35.0 Background retinopathy and retinal vascular changes
• No Change - Code also
• Revise from - any associated hypertension (I10.-)
• Revise to - any associated hypertension (I10)

Chapter 12 (Skin and subcutaneous tissue) has a few changes that we might encounter when the skin is irritated from friction or body fluid contact (ie, eyelid skin irritation due to eye tearing). That change under L24 (Irritant contact dermatitis) is:

• Add - L24.A Irritant contact dermatitis due to friction or contact with body fluids
• Add - L24.A9 Irritant contact dermatitis due friction or contact with other specified body fluids

Chapter 13 (musculoskeletal and connective tissue) has one relevant change under M35.01 Sjögren syndrome.

• Revise from - M35.01 Sicca syndrome with keratoconjunctivitis
• Revise to - M35.01 Sjögren syndrome with keratoconjunctivitis

There is a single change to Chapter 17 (symptoms, signs, etc.) due to the M35.01 language change above. The “excludes1” note under R68.2 Dry mouth changed:

• No Change - Excludes1:
• Revise from - dry mouth due to sicca syndrome [Sjögren] (M35.0-)
• Revise to - dry mouth due to Sjögren syndrome (M35.0-)

Chapter 19 (injury, poisoning, external causes) has some minor changes:

• No Change - S00.1 Contusion of eyelid and periocular area No ChangeExcludes2:
• Revise from - contusion of eyeball and orbital tissues (S05.1)
• Revise to - contusion of eyeball and orbital tissues (S05.1-)
• No Change - S01.0 Open wound of scalp
• No Change - Excludes1:
• Revise from - avulsion of scalp (S08.0)
• Revise to - avulsion of scalp (S08.0-)

Chapter 20 has changes, but you won’t need to use or track these unless you have a state Medicaid program that requires them.

Chapter 21 (factors influencing health status, etc.) has only a few minor changes. One is under Z01.0, and the other is under Z79.4 (Insulin), which has a change from “excludes1” to “excludes2”:

• No Change - Z01.02 Encounter for examination of eyes and vision following failed vision screening
• No Change - Excludes1:
• Revise from - examination for examination of eyes and vision with abnormal findings (Z01.01)
• Revise to - encounter for examination of eyes and vision with abnormal findings (Z01.01)
• Revise from - examination for examination of eyes and vision without abnormal findings (Z01.00)
• Revise to - encounter for examination of eyes and vision without abnormal findings (Z01.00)
• No Change - Z79.4 Long term (current) use of insulin
• Delete - Excludes1: long term (current) use of oral antidiabetic drugs (Z79.84)
• Delete - long term (current) use of oral hypoglycemic drugs (Z79.84)
• Add - Excludes2: long term (current) use of oral hypoglycemic drugs (Z79.84)
• Add - long term (current) use of oral antidiabetic drugs (Z79.84)

Lastly, the recent Chapter 22 (codes for special purposes) had some new codes under U09 Post COVID-19 condition, but for most of us these would be rare.

Guideline changes

The Official Guidelines for 2022 can be accessed via the same link as above and then following the link to the “FY 2022 ICD-10-CM Coding Guidelines.”

Under “laterality” is the following change: … Codes for “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side and it is not possible to obtain clarification.

The “Use of Sign/Symptom/Unspecified Codes” section has this new text: As stated in the introductory section of these official coding guidelines, a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. The importance of consistent, complete documentation in the medical record cannot be overemphasized …

The Chapter 4 guidance has this change (new language is bold): Additional code(s) should be assigned from category Z79 to identify the long-term (current) use of insulin, oral hypoglycemic drugs, or injectable non-insulin antidiabetic, as follows: If the patient is treated with both oral medications and insulin, both code Z79.4, Long term (current) use of insulin, and code Z79.84, Long term (current) use of oral hypoglycemic drugs, should be assigned.

In Section IV.F.3, which covers “Diagnostic Coding and Reporting Guidelines for Outpatient Services”, new language emphasizes what we should already know about the level of detail required: Code to the highest level of specificity when supported by the medical record documentation.

Summary

While there are few actual code changes for 2022 that affect us in eye care, it is important to always use the most current code set and Official Guidance.

And as always, “Good coding to you.” OP